| NPI | 1528355658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 34766) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: SC LL 34766) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-07-10 |
| Last Update Date | 2018-01-29 |